It's so different. How much easier it is to do my job when I don't have some old timer who's used to working with 100 other RTs and the "proper" way to do things who's breathing down my neck and insinuating the entire time that I don't know what I'm doing. It's me, I'm it, they're my decisions. It needs doing, I do it.
I had a performance evaluation last week with my new boss, who if I could elevate to sainthood you bet your ass the papers would be in already. This isn't entirely because she likes me. It's because she's giving me a performance evaluation on a monthly basis whether I need it or not, and as much as I did like my old manager (when many did not) with her I don't need to know that she's talking to me because there's something bad she's got to tell me. I'm nervous when I'm up for a performance evaluation, yes, but oh, is it ever a good feeling to be told I'm respectful, I'm polite, I'm very pleasant, and that I'm skilled, with a smile on her face that speaks of her pride.
I spent so much of my earlier career and my time as a student feeling like a knownothing fuckup and so being not only told that I awesome at my job, to have a weekend like the last two weekends I've worked, where it's non-stop shit and I'm the only one in the hospital, who's taking and prioritizing and getting my shit done and everybody sees me with a smile on my face, even if the ones who see me more frequently do remark that I look particularly tired.
I'm not the neb-jockey or the tank-bitch. I'm having long and engaged conversations with the medical director of intensive care, wherein I manage to convince the guy (chest x-ray interpretation and ABGs later) that if he's convinced that him being a long-term ventilator patient is an inevitability, why are you putting it off until he crashes? As it stood, after the intubation, his CO2 rose from 50sish to nearly 90. Two weeks later, we're having trouble keeping his CO2 in the 70s. His intubation came at just the right time, twelve hours before he spiked a massive temperature and his white blood cell count doubled.
The conversation involved me doing what the poppa-smurf from Far Away has taught me to do all along. I was pleasant and polite, I was not a knowitall. I asked questions, legitimate questions, posed with palms open, and I got answers. I argued my point, I conceded others. In the end I got what I wanted, which was what's best for the patient. A younger RT in me would have been just smug that I got my way.
I'm flexing my respiratory brain, answering questions with expertise. We performed an honest-to-God apnea test the first week I was there, with all the nurses o.Oing at me in somewhat-awe because I knew what we were talking about and knew how to do it. I was teaching the newest ICU nurse of them all, friendliness and engagement intact. These people may run my ventilator out of necessity when I'm not around, but there is no sense of "I-could-do-your-job" -- in fact, them running my ventilator gives them an enormous appreciation for the amount of expertise necessary to do the knob-twiddling I do. They always call me when they're not sure.
I've inserted arterial lines (two!) with no supervision, and though my "If I didn't do it 100% independently I fucked up" nature was prevailing in my head, I got praise from nurses for things like cleaning up my mess. I had a co-worker snap at me out of frustration at her lack of understanding about APRV, an admittedly-esoteric mode that gets used infrequently and only in the sickest of patients. While I felt quite upset at her frustration (I took it rather personally) I went to my manager about it afterwards, trying to determine what I could do differently next time to not make her feel stupid, and was instead praised. She had apparently gone to see her first, and talked about how bright I was. My argument regarding the mode was not postulated in hubris, but was rather formulated using science, and a hastily-jotted mathematical equation for mean airway pressure. I think I blew her away that I came up with the equation off the top of my head. Now, my manager wants to seize upon my understanding of this mode for teaching purposes.
Even the members who are less easy to get along with I seem to have bonded with, along more nerd-related lines. It appears my Moko was right; a change in provinces made it a lot easier to escape that cloud of what-I-was-as-a-student that seemed to permeate my reputation.
I feel accomplished. I feel proud. I haven't taken a pay cut but rather a work increase; instead of feeling unfulfilled by my job I'm feeling like I get to stretch. Instead of being somebody's bitch, I get to be the recognized expert that I'm licensed to be.
I'm remembering why I love my job.